ICD-10 Code S79.141A: Salter-Harris IV fracture, right distal femur

Key takeaways

ICD-10 Code S79.141A describes a Salter-Harris Type IV physeal fracture of the lower end of the right femur, at the initial encounter. It is billable.

The 7th character ‘A’ designates active treatment at an initial encounter. Six valid extensions exist (A, D, G, K, P, S), covering healing stages and sequelae.

Salter-Harris Type IV fractures cross the epiphysis, physis, and metaphysis at once. That makes laterality and fracture type documentation decisive for claim approval.

Practice management software like Pabau keeps fracture coding, treatment notes, and electronic claims in one system, so nothing is missing at submission.

ICD-10 Code S79.141A is a billable ICD-10-CM diagnosis code for a Salter-Harris Type IV physeal fracture of the lower end of the right femur. It applies at the initial encounter, and it is valid for claim submission under the current fiscal year CMS ICD-10-CM code set. Passing payer edits takes precise documentation of laterality, fracture type, and encounter stage.

This reference covers the code structure, the Salter-Harris classification behind it, and all six valid 7th character extensions. It also covers the sibling codes coders confuse it with, and the five documentation elements that decide whether a claim clears the first time.

What is ICD-10 Code S79.141A?

ICD-10 Code S79.141A identifies a Salter-Harris Type IV physeal fracture at the lower end of the right femur, coded for an initial encounter. Three descriptors make this code precise.

They are the fracture type (Salter-Harris IV), the anatomical site (lower end of the right femur), and the encounter qualifier. Initial means the patient is actively receiving treatment for the injury. All three must be confirmed in the medical record before this code can be assigned.

The distal femoral physis is one of the most commonly injured growth plates in children and adolescents. According to the CDC/NCHS ICD-10-CM official tabular list, S79.141A sits within Chapter 19, which covers injury, poisoning and certain other consequences of external causes.

The fracture coding guidelines in ICD-10-CM Section I.C.19.a govern its use. These guidelines dictate when each 7th character is appropriate and how to sequence fracture codes alongside external cause codes.

Code hierarchy breakdown

Clinical description: Salter-Harris Type IV fracture of the distal femur

The Salter-Harris classification system grades physeal fractures in skeletally immature patients from Type I (least severe) through Type V (most severe). The grade reflects the anatomical planes the fracture crosses. Type IV is one of the more complex patterns.

The fracture line passes through the epiphysis, across the physis (growth plate), and into the metaphysis. That triplanar path is what separates Type IV from Types I through III. The fracture crosses the articular surface and the growth plate at once. Growth disturbance and joint incongruity are both possible if it is managed as a simpler pattern.

For the distal femur specifically, this matters most in patients between 2 and 17 years of age. The physis is still open at that stage, so growth arrest carries clinically significant consequences.

Orthopedic and pediatric providers code these encounters in physical therapy EMR software or orthopedic EHR platforms. Before assigning any S79 physeal fracture code, confirm that growth plate status is documented in the chart.

Salter-Harris classification at a glance

7th character extensions for ICD-10 Code S79.141A

The 7th character tells payers and auditors where the patient sits in the treatment timeline. It is required on every fracture code, not an optional suffix.

Using the wrong extension is one of the most common fracture coding errors caught on medical records audits, per ICD-10-CM Official Guidelines Section I.C.19.a. In orthopedic medical billing, that qualifier decides which reimbursement pathway the claim follows.

A patient can be coded with “A” (initial encounter) across multiple visits, as long as active treatment continues. That includes each surgical procedure and each cast change. The transition from “A” to “D” does not occur at the second visit. It happens when the treating provider determines the acute treatment phase has concluded.

Related and sibling ICD-10 codes for S79.141A

Coding accuracy requires knowing when to shift from S79.141A to a sibling or adjacent code. The most common confusion involves laterality (left vs. right vs. unspecified) and encounter type.

The AAPC ICD-10-CM code lookup and WHO’s ICD-10 browser both provide quick cross-reference tools for practitioners navigating these distinctions. The full S79 category also covers adjacent thigh injuries such as S76.909A.

Two digits do the work inside this subcategory, and mixing them up is the root of most sibling-code errors. The 6th character carries laterality: 1 for the right femur, 2 for the left, and 9 for an unspecified side. The 5th character carries the Salter-Harris type, so S79.13x codes are Type III and S79.14x codes are Type IV.

Non-physeal fractures at the same site sit outside this subcategory, in the S72.4 series. One example is S72.414P.

Documentation requirements for ICD-10 Code S79.141A

A correctly assigned S79.141A diagnosis code is only as defensible as the documentation behind it. Payers applying medical necessity edits and post-payment audit contractors look for five specific elements in the medical record. Missing any one of them creates exposure for a take-back or denial.

Practices submitting through the Claim.MD integration can validate code-level data before transmission. That cuts front-end rejections on physeal fracture claims.

• Laterality: The record must explicitly state “right” femur. A note that says “distal femur fracture” without specifying side does not support S79.141A and defaults to the unspecified code S79.149A.
• Salter-Harris type: The imaging report or clinical documentation must name the fracture type as “Type IV.” It can instead describe a fracture pattern crossing the epiphysis, physis, and metaphysis. A radiologist’s report that simply reads “physeal fracture” does not support Type IV specificity.
• Anatomical site: “Lower end” or “distal femur” must appear in the documentation. A fracture of the femoral shaft uses a different code range entirely, such as S72.345C.
• Encounter type: The clinical note must confirm the visit is for active treatment to justify the “A” extension. Routine follow-up without active intervention uses “D” unless healing is delayed (G), has failed (K), or healed abnormally (P).
• Open vs. closed status: The record should confirm the fracture is closed. Open fractures are coded differently, and many EHR templates include this field within the injury assessment section.

Those five elements are not independent of the code. Each one defends a specific character of S79.141A.

Orthopedic practices coding pediatric distal femur injuries do better with documentation templates that prompt for all five elements at the point of care. Building those prompts into the EHR template is more reliable than a post-visit chart review.

When submitting a clean claim for a pediatric fracture encounter, check every field the payer uses to test medical necessity. Populate all of them before the claim leaves the practice.

Coding guidelines and common errors with S79.141A

Most coding errors on S79.141A fall into four patterns. Each one is preventable with a pre-submission checklist built into the practice’s workflow. Practices running orthopedic or sports medicine software should flag all four in claim scrubbing.

Error 1: Missing or incorrect 7th character

Submitting S79.141 without the 7th character extension is a claim rejection waiting to happen. ICD-10-CM requires the full 7-character code for all fracture codes in Chapter 19. Similarly, using “D” on what is still an active treatment visit (such as a cast change three days post-injury) is an audit finding. The 7th character must reflect the clinical reality of the visit, not a default entry.

Error 2: Defaulting to the unspecified laterality code

When laterality is documented in the medical record, coders must assign the laterality-specific code. Using S79.149A (unspecified femur) when the record clearly states “right” is considered a coding deficiency and may be flagged during a payer audit. This error reduces specificity and can trigger medical necessity reviews.

Error 3: Salter-Harris type mismatch

Each Salter-Harris type maps to a different subcategory within S79. A Type II fracture documented in the record but coded as Type IV is both a clinical error and a billing error. The same is true in reverse. Coders should never assign the Salter-Harris type from imaging impressions alone. The treating clinician’s documented diagnosis takes precedence for coding purposes.

Error 4: Sequela vs. subsequent encounter confusion

Sequela codes (7th character S) apply after active treatment of the injury has concluded. The patient is presenting with a late effect, such as a growth plate arrest or an angular deformity. Using “S” during the active treatment phase is a coding error with reimbursement consequences. So is using “D” when a late effect is the primary reason for the visit.

The denial codes tied to these sequencing errors most often arrive as medical necessity denials (CO-50) or missing/incomplete information denials (CO-16). Practices with proactive denial management workflows catch these before they reach secondary review.

How Pabau supports fracture coding and claim submission

In most practices, S79.141A gets assembled from three places. The imaging report carries the Salter-Harris type, the operative note carries open or closed status, and the encounter note carries the treatment stage. Anything missing tends to surface weeks later, in a remittance.

Pabau keeps those records in one client file. Treatment notes, images, and consent forms sit against the appointment itself. The encounter template can prompt for laterality and fracture type while the patient is still in the room. Claims then go out electronically through Claim.MD, so a clearinghouse check runs before the payer ever sees the file.

The outcome is fewer physeal fracture claims coming back for rework. You also spend less time reconstructing what the chart should have said. Pabau’s claims management tools follow each claim from charge capture through to remittance, so you can see which codes are getting paid.

Streamline orthopedic and pediatric fracture coding

Pabau keeps client records, treatment notes, and electronic claims in one system. Orthopedic and sports medicine practices can check a fracture code before the claim leaves the front desk.

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Conclusion

Fixing S79.141A at charge capture takes seconds. Fixing it after a denial takes a rework cycle and a delayed payment. That difference is the whole argument for prompting all five documentation elements inside the encounter template.

There is a clinical reason to get it right as well. A Type IV pattern at the distal femur can end in growth arrest. The record that supports the code is also the record the next provider reads. Coding it precisely and documenting it fully are the same job.

If your practice reworks physeal fracture claims more than once a quarter, start with the encounter template. Book a demo to see how Pabau handles fracture coding and electronic claim submission.

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